US 3182656 A
Description (OCR text may contain errors)
J. L. PYNE SURGICAL SHEET May 11, 1965 2 Sheets-Sheet 1 Filed April 24, 1962 a w T SUPINE PATIENT Jessie L. Pyne INVENTOR.
May 11, 1965 J. L. PYNE 3,182,656
SURGICAL SHEET Filed April 24, 1962 2 Sheets-Sheet 2 Fig 5 Jessie L. Pyne INVENTOR.
' BY M kzzm United States Patent Office 3,182,65fi Patented May 11, 1965 3,182,656 SURGICAL SHEET Jessie L. Pyne, 425 Pine! Ave, ()rcutt, Calif. Filed Apr. 24, 1962, Ser. No. 190,962 6 Claims. (Cl. 128-l32) This invention relates to a special purpose surgical sheet, more particularly a sterile-type vaginal-hysterectomy sheet which is expressly designed and efiicaciously adapted for vaginal surgery and which lends itself to aseptic techniques and procedures which are now endorsed and, as a matter of fact, are strictly enforced in virtually every theater of surgery.
To assist the reader in categorizing and fully comprehending the instant concept it is to be pointed out at the outset that it has nothing to do with an examination or treatment sheet. Nor can it be used for such examinations. It is exceptionally large in size (132) twice the width of commonly used cover-sheets, is of unitary laminated construction, is clavable (launderable) and suc- 'cessfully applicable and removable and appropriate only for the newest type of vaginal surgery. As with other surgical sheets the patient is completely covered (entire body and hair of the head) the only exposure being the mouth and nose, taking into consideration the mode and kind of anesthesia being employed.
Persons conversant with operating room practices and procedures are aware that all steps taken by those present in the operating room and equipment and appliances involved have to do with the deletion wherever possible, of any recognized sources of contamination. Keeping in mind the subject matter under advisement it may well be pointed out that heretofore leggings of various types over which a laporotomy sheet is placed were used. Such leggings have been discarded and two large double sheets were then placed over the stirrup area. Currently recommended up-to-date vaginal surgery involves the use of knee-chest stirrups. In using the latter the aforementioned double sheets were then found to be inadequate. Stirrup coverings ofany and all types along with an incisi on sheet resulted in the presence of three openings or joints an arrangement which proved out to be unsatisfactory in surgery practices by reason of the fact that asepsis enters through such vulnerable spaces. It follows that the elimination of such objectionable spaces and the reduction of apertures to an absolute minimum is now regarded as a must. It follows that an objective in the instant disclosure is the provision of a flexible sterile clavable surgical sheet having but a single incision slot or opening and featuring contoured but conformable sheet components or portions which lend themselves adaptable to currently used stirrups.
In attempting to solve the overall problem and with a view toward considering the whole background of the matter other factors of a relevant nature come into consideration here. The aforementioned new type vaginal hysterectomy requires the patient to assume a supine position, knees on chest, leaning or propped outwardly. The buttocks are perched on the edge of the operating table, a tray is placed at the lower edge of the incision opening its purpose being to accommodate a culdoscopy (procedure now practiced along with surgery) and a suitable photographic apparatus. To the ends and results desired a sheet to be suitable must fit tightly back, in
placement of the culdosco-pe. To cope with this other suitably placed fasteners (Velcro straps or tapes) are used.
in carrying out the principles of the instant invention a simple, practical economical and reliable surgical sheet has been evolved, produced and successfully used. It is such in construction that it will reliably remain in its intended or given position throughout the entire surgery procedure. It can he placed, packed by a surgical team without contamination. The unconscious patient, when this unique sheet is employed, is completely covered by the cooperating components or portions of the sheet from the neck down. The toes are in reception and retaining cups formed by darts in a manner to be hereinafter described. Being a surgical sheet the sheet material must be heavy and is preferably of double thickness. The sheet is designed to be packed with towels, sponges, pads and belts all wrapped in a double thickness cover and then rewrapped in another double thickness wrapper, susceptible of being autoclaved for 45 minutes at 250 pounds of pressure, dried for 15 minutes and stored in a surgery storage cupboard. Other practices which perhaps need not be mentioned at this stage are necessarily considered in evaluating the nature and extent of the achievement herein under advisement.
It will be helpful for the reader to take into account the fact that the improved sheet is intended to be placed in position on the surgically prepared patient by surgically prepared personnel and because of the shape and construction this step can be easily accomplished. Also experience shows that it stays put, remains uncontaminated during the surgical procedure and therefore complies with the requirements of the surgical aseptic technique. Then, too, because of its appropriate design and construction it is in readiness for expedient use whenever necessary or desired.
These together with other objects and advantages which will become subsequently apparent reside in the details of construction and operation as more fully hereinafter described and claimed, reference being had to the accompanying drawings forming a part hereof, wherein like numerals refer to like parts throughout, and in which:
FIGURE 1 is a view in perspective depicting the patient on the operating table in readiness for surgery and with the surgical sheet, constructed in accordance with this invention, applied and readied for use;
FIGURE 2 is a view in side elevation of the illustration covered in FIGURE 1;
FIGURE 3 is a top plan view, with portions broken away, and on a relatively small scale showing the general ovate configuration of the improved sheet;
FIGURE 4 is a view in side elevation which may be said to be a view observing the construction of FIGURE 3 in a direction either left or right as the case may be;
FIGURES 5 and 6 are enlarged fragmentary detail sections taken on the line 55 and 6--6, respectively, of FIG. 3; and
FIGURE 7 is a fragmentary elevational view detailing the component parts of one of the aforementioned strap fasteners perhaps best known in the trade as Velcro.
Briefly and broadly described the invention comprises a surgical sheet of a size that it may be conveniently and adequately spread to completely cover the patient except the mouth and nose area while she is in a supine knee-onchest position on an operating table, said sheet having a prescribed shape in top plan such that it conformingly assumes and retains its applied position and, because it conformably adapts itself to the patient stays put, said sheet having but a single opening (the incision aperture) which is constantly unobstructed and unlikely to shift from its oriented position in alignment with the vaginal area.
In order to appreciate the adequacy of the improved sheet it should be kept in mind that experimental models are 82 inches by 132 inches. In reducing the invention to practice two sheets were required, one for each side, and a half sheet for the center section or part. Each sheet was assembled by sewing the center to each side; then sewing the darted, cutout section on each side piece together; following this the entire two single sheets were sewn together, wrong sides out, to the neck edge, the sheet was then turned right side out through the neck openings and closed by sewing along the edge on the right side of the sheet. All seams were then assembled to match, and the entire sheet quilted. Velcro material fasteners (a clavable, nylon material, which when pressed together adheres firmly forming soft, sterile, inbuilt, fasteners) were affixed and sewn into place.
With reference first to FIGS. 5 and 6 it will be evident that the three-part top lamination or ply is designated generally by the numeral 10 and the correspondingly constructed bottom part or lamination is designated at 12. The outer perimeter or marginal edges are turned in as at 14 and suitably stitched as at 16. Except for the incision opening or slot 18 (FIGS. 1, 3 and 5) the sheet considered as a double-thickness-entity is imperforate. The size of the opening 18 is as required in surgical vaginalhysterectomy sheets in the category under consideration. The marginal edges of the opening 18 are reinforced by a binding tape 20 stitched in place as at 22. In fact, the two plies of material 10 and 12 are stitched (see the rectangular outline) as at 24, to stiffen the marginal portions of the two plies immediately around the access opening 18.
To avoid complication (in respect to whether the sheet is of one ply or a plurality of plies) and construing it as a one-piece sheet, regardless of material and manner of stitching same, it will be noted that viewed in top plan as in FIG. 3 is central generally ovate in form. The generally rectangular component or part is differentiated from the complemental portions and will now be designated here as an elongated apron. The companion components, which are complemental thereto, are segmental in shape and are each the same in construction. The apron is denoted at 26 and the left and right components or skirt portions are denoted at 28 and 30 respectively. The inner lengthwise edges of these skirt portions 28 and 30 are stitched to the lengthwise companion edges of the apron 26 as designated generally at 32. The forward or upper half-portion of the apron denoted at 34 is intended to overlie the patients body ranging from her neck to the vaginal region as shown best in FIG. 1. The rearward or lower half-portion 36 is such in area that it drapes over the edge of the operating table A, that is the rear transverse end and this end is toward the base B not, of course, dropping as low as the floor surface. The aforementioned incision opening 18 is at the juncture of the two areas or half-portions 34 and 36 which positions it as designated in FIG. 1 for accessibility to the surgeon who usually sits on a stool or the like within the zone of operation. The segmental skirt portions 28 and 38 considered flatwise could perhaps be described as approximately semi-circular in plan. Perhaps it is more appropriate to say that each skirt portion is segmental in plan and that the plies are stitched together and reinforced by way of the lines of stitching designated at 40. The radial seams 42 at both sides (right and left) designate the stitched seams which mark the darts which have been cut out and which as a result of the final stitching define concave pockets 44 which are suflicient to accommodatingly receive the toes of the patient in a manner approximately depicted but not detailed in FIG. 1 and also in FIG. 2.
It will be evident that this type of surgical sheet may be easily placed over the leg area by two assistants surgically scrubbed and gowned and without the need of tugging and clipping loose ends. In this way the likelihood of contamination is reduced to a significant minimum.
The patient when this sheet is used is completely covered by it from the neck down, toes being in the cups formed by the aforementiont d darts as at 44. The aforementioned fasteners may, of course, vary in each construction. For the purpose of the presently used sheets fasteners positioned at the proper points as designated in FIG. 1 are employed in order to gather the skirt portions 28 and 36 so that they encompass the limbs and supporting stirrups and other appliances underneath the sheet (not shown). Each fastener comprises tapes one of which is denoted at 45 (FIG. 7) and having one end stitched in place at 48, the surface being provided with loops to receive the multiplicity of hook-like spines 52 on the complemental tape 54 which latter tape is stitched at the desired place as at 56.
rieily summarized it will be noted that the sheet constitutes a novel contribution to the art particularly in that it is characterized by a single aperture for incision and surgery needs. The whole sheet can be rolled up, sterilized and placed on the abdominal surface, unrolled from the abdomen to the neck, abdomen to the bottom or drop leaf (not detailed) of the table. Then, with the nurse, scrubbed and surgically ready, and stationed on either side of the patient the toe of the patient can be grasped, raised and placed over the stirrup supported foot and limb. The Velcro tapes can then be pressed, one to the neck tape, one to the front panel tape, making a legging or canopy effect, keeping the sheet snug, free from slipping objectionably into the field of operation. Hence with the sheet so clipped and fastened back, the surgeon can sit before the pelvic fenestration and work without pushing back sheet folds that might otherwise flap about and give trouble. The surgeon can move table up for placement of cameras, cautery or other special tools close to the area without obstruction of in-the-way sheet folds or flaps. The double thickness of the sheet retards and reduces seepage to a minimum. There are no tails to cope with. The sheet being oval reaches to the surgical level from the floor. It actually replaces the use of many sheets (sometimes four) and is otherwise designed and adapted to help the surgeon, nurses and other attendants.
It is submitted that a careful consideration of the description together with the figures of the drawings and in relation to the invention as claimed will enable the reader to obtain a clear and comprehensive understanding of the herein disclosed surgical sheet and the features and advantages attending the same. Therefore, a more extended description is regarded as unnecessary.
The foregoing is considered as illustrative only of the principles of the invention. Further, since numerous modifications and changes will readily occure to those skilled in the art, it is not desired to limit the invention to the exact construction and operation shown and described, and accordingly all suitable modifications and equivalents may be resorted to, falling within the scope of the invention as claimed.
What is claimed as new is as follows:
1. For use in an operating room during the course of performing a vaginal-hysterectomy and during which procedure the patient assumes a supine position with her limbs constrained and oriented in a given manner with customarily used knee-chest stirrups, and wherein there is a tray atop the operating table to accommodate a culdoscopy or the like; an improved anti-contamination coverall one piece surgical sheet made of two-ply autoclavable surgical sheeting, said sheet being generally ovate in plan and. consisting of three component parts; namely, an elongated centrally located component generally rectangular in plan and constituting an apron, and a pair of companion segmental-shaped components to the left and right, respectively, of and complemental to said apron, said segmental-shaped components having inward lengthwise edges abutting and stitched to the respective lengthwise edges of said apron and consituting skirt portions, said apron having a forward half-portion and a rearward half-portion adapted to drape itself over the operating end of the operating table with the terminal free end approaching the floor and hanging down in front of the seated surgeon, that portion of said apron at the juncture of said forward and rearward half-portions having a single marginally reinforced elongated aperture for incision use by the surgeon, and all of said components being otherwise imperforate and of ample stiffness to maintain the shape and position imparted thereto when the sheet is being used.
2. The surgical sheet according to claim 1, and wherein each segmental-shaped skirt portion'has its median portion possessed of a degree of fullness capable of being fashioned into an expansible and contractible upstanding canopy, each canopy being amply spacious and roomy to accommodate, without binding, the limb and stirrup which is hooded therein.
3. The sheet according to claim 2, and wherein each canopy is substantial and upstanding when in use, is capable of being circumferentially gathered and thus diminished in cross-sectional area for self-shape retention requirements, but is also susceptible of being collapsed into compact and convenient size and form for handling, folding and storage, and quick separable and connectible fasteners accessibly mounted on exterior surfaces of the median and respective end portions of said segmental skirt portions, said fasteners being made of sterile clavable material and when fastened serving to gather the folds and provide the pocketing function of each canopy in a manner to avoid exasperating slippage or accidental displacement of the sheet once it is manually applied and fastened by a nurse or other attendant.
4. A vaginal-hysterectomy sheet comprising: an anticontaminating sheet made of superimposed autoclavable plies of conventional sterile surgical sheeting, the overall sheet being substantially ovate in plan and characterized by three companion sections; namely, an elongated twoply centralized quilted body section, generally hourglassshaped in plan and constituting and providing a foldable but spreadable apron, and duplicate left and right two-ply side sections substantially commensurate in length with said body section, generally segmental in plan, quilted and constituting manually gatherable skirt portions and having their inwardly disposed lengthwise edges conformingly delineated and oriented with and stitched to the respectively coacting lengthwise edges of said body section, said body section being characterized by an upper half-portion adapted to be spread flatwise over the torso of the patients body ranging from her neck to the gradually narrowing median vaginal covering region, and a lower half-portion extending rearwardly therefrom and to fall and drape itself over the end of the operating table in a manner to function as a shield in front of the seated surgeon, a median part of said centrally narrowed portion having a single elonagted incision aperture, said side sections being provided exteriorly at forward, rearward and intermediate areas with quick separable and connectible Velcro fasteners which when properly oriented and connected serve to gather and contract the median portions of said side sections in a manner to define and provide upstanding canopy-like cups which hood over and enclose the stirruped outspread feet and legs of the patient, all of said sections except for said single apertured body sections except for said single section being imperforate.
5. The sheet defined in claim 4, and wherein the doubleply thickness while permitting the overall sheet to be rolled for handling, autoclaving and storage functions serves to permit the respective sections to assume and amply retain the shape needed to avoid accidental slippage and/ or displacement when in use, and wherein the marginal edges of said aperture are bordered and reinforced by an attached binding tape and portions of the plies proximal to and encompassing said aperture are stitched together and thus quilted.
6. The sheet defined in claim 4, and wherein each transverse median portion of each side section opposite said aperture embodies-a stitched reinforced dart transforming the thus darted portion into an upstanding self-shapesustaining canopy.
References Cited by the Examiner UNITED STATES PATENTS 1,544,692 9/25 Shane l28-29:2 X 1,724,443 8/29 Wheeler l29- 292 XR 1,867,425 7/32 Swetzel 5-334 2,593,121 4/52 Djorup 128-292 XR 2,715,902 8/55 Shaffer 128-132 3,030,957 4/62 Melges 128-292 3,034,132 5/62 Landsberger et al. 269.5
OTHER REFERENCES J.A.M.A., Oct. 18, 1958, p. 930.
RICHARD A. GAUDET, Primary Examiner.
RICHARD J. HOFFMAN, Examiner.